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Hiatal hernia

Hernia - hiatal

 

Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest. The diaphragm is the sheet of muscle that divides the chest from the abdomen.

Causes

 

The exact cause of hiatal hernias is unknown. The condition may be due to weakness of the supporting tissue. Your risk for the problem goes up with age, obesity, and smoking. Hiatal hernias are very common. The problem occurs often in people over 50 years.

This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus.

Children with this condition are most often born with it (congenital). It often occurs with gastroesophageal reflux in infants.

 

Symptoms

 

Symptoms may include:

  • Chest pain
  • Heartburn, worse when bending over or lying down
  • Swallowing difficulty

A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are due to the upward flow of stomach acid, air, or bile.

 

Exams and Tests

 

Tests that may be used include:

  • Barium swallow x-ray
  • Esophagogastroduodenoscopy (EGD)

 

Treatment

 

The goals of treatment are to relieve symptoms and prevent complications. Treatments may include:

  • Medicines to control stomach acid
  • Medicine to strengthen the muscles in the lower esophagus that keeps stomach contents from backing up
  • Surgery to repair the hiatal hernia

Other measures to reduce symptoms include:

  • Avoiding large or heavy meals
  • Not lying down or bending over right after a meal
  • Reducing weight and not smoking
  • Raising the head of the bed 4 to 6 inches

If medicines and lifestyle measures do not help control symptoms, you may need surgery.

 

Outlook (Prognosis)

 

Treatment can relieve most symptoms of hiatal hernia.

 

Possible Complications

 

Complications may include:

  • Pulmonary (lung) aspiration
  • Slow bleeding and iron deficiency anemia (due to a large hernia)
  • Strangulation (closing off) of the hernia

 

When to Contact a Medical Professional

 

Call your health care provider if:

  • You have symptoms of a hiatal hernia.
  • You have a hiatal hernia and your symptoms get worse or do not improve with treatment.
  • You develop new symptoms.

 

Prevention

 

Controlling risk factors such as obesity may help prevent hiatal hernia.

 

 

References

Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.

Ferri FF. Hiatal hernia. In: Ferri FF, ed. Ferri's Clinical Advisor 2015. Philadelphia, PA: Elsevier Mosby; 2015:p. 571-2.

Petersen RP, Pellegrini CA, Oelsclanger BK. Hiatal hernia and gastroesophageal reflux disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 44.

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          Review Date: 4/20/2015

          Reviewed By: Subodh K. Lal, MD, Gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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